接受孤立冠状动脉旁路移植术的患者术前右心导管检查参数与预后之间的关系。

0 CARDIAC & CARDIOVASCULAR SYSTEMS Interdisciplinary cardiovascular and thoracic surgery Pub Date : 2024-09-04 DOI:10.1093/icvts/ivae158
Irbaz Hameed,Ralf Martz Sulague,Eric S Li,Doruk Yalcintepe,Katherine Candelario,Andrea Amabile,Victory B Effiom,Haleigh Larson,Arnar Geirsson,Matthew L Williams
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摘要

在冠状动脉旁路移植术(CABG)前,右心室导管检查可获取有助于确定预后的信息。在这项研究中,我们评估了接受孤立的冠状动脉旁路移植术的患者术前右心导管检查参数与预后之间的关联。我们对 2013 年至 2021 年期间在我院接受孤立式心血管移植术的所有患者进行了回顾性查询,这些患者在接受孤立式心血管移植术前 14 天内也接受了术前右心导管检查。共有 2343 名患者接受了孤立的 CABG 手术,其中 78 名患者(20 名女性,占 25.6%)被纳入最终分析。经多变量回归,中心静脉压与手术死亡率显著相关(几率比 1.14,95% 置信区间 1.02-1.27,P = 0.024)。术前心脏指数与重症监护室住院时间(几率比0.72,95%置信区间0.62-0.84,P<0.001)和肌力支持持续时间(几率比0.76,95%置信区间0.63-0.92,P<0.01)显著成反比。对于高危患者群体,尤其是术前超声心动图检查发现左室功能明显不全而需要接受经皮冠状动脉介入治疗、左室辅助装置或心脏移植手术的患者,应考虑通过右心导管检查对术前心功能进行评估。此外,右心导管检查还有助于指导术前优化和术中、术后决策。
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Association between preoperative right heart catheterization parameters and outcomes in patients undergoing isolated coronary artery bypass grafting.
Right ventricular catheterization may capture information that can help define prognosis before coronary artery bypass grafting (CABG). In this study, we evaluate the association between preoperative right heart catheterization parameters and outcomes of patients undergoing isolated CABG. All patients undergoing isolated CABG at our institution from 2013 to 2021 who also underwent preoperative right heart catheterization <14 days prior to isolated CABG were retrospectively queried. A total of 2343 patients underwent isolated CABG of whom 78 patients [20 (25.6%) female] were included in the final analysis. On multivariable regression, central venous pressure was significantly associated with operative mortality (odds ratio 1.14, 95% confidence interval 1.02-1.27, P = 0.024). Preoperative cardiac index was significantly inversely associated with intensive care unit length of stay (odds ratio 0.72, 95% confidence interval 0.62-0.84, P < 0.001) and duration of inotropic support (odds ratio 0.76, 95% confidence interval 0.63-0.92, P < 0.01). Assessment of preoperative cardiac function by right heart catheterization should be considered in high-risk patient populations, particularly those who have significant left ventricular dysfunction on preoperative echocardiography that would make them candidate for percutaneous coronary intervention, left ventricular assist device or heart transplantation. Further, right heart catheterization can help to guide preoperative optimization and intra-/postoperative decision-making.
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